Implementation of a dissonance-based, eating disorder prevention program in Southern, all-female high schools

Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis

There is a consistent link between perfectionism and eating disorders, however no meta-analysis to date has synthesized this literature in children and adolescents. We hypothesized that there would be significant, small pooled correlations between perfectionism dimensions and eating disorder symptoms in children and adolescents. Published, peer-reviewed articles with standardised measures of perfectionism and eating disorder symptoms were included. Articles were excluded if the age range was over 18 years. Overall, 39 studies were included (N = 13,954 participants, M age = 13.7 years). Total perfectionism (r = 0.25), perfectionistic strivings (r = 0.21), and perfectionistic concerns (r = 0.31) had significant positive associations with eating disorder symptoms. Most studies were rated as fair or good quality. Limitations included high heterogeneity, insufficient studies to investigate age as a moderator, the inclusion of only English articles, and predominately cross-sectional studies which precluded causal inference. Higher perfectionism was associated with greater eating disorder symptoms in children and adolescents. Future research should focus on longitudinal studies of eating disorder symptoms in children and adolescents.

Prevention and early intervention in eating disorders: findings from a rapid review

BACKGROUND

Eating disorders (EDs) are complex psychological disorders, with low rates of detection and early intervention. They can lead to significant mental and physical health complications, especially if intervention is delayed. Given high rates of morbidity and mortality, low treatment uptake, and significant rates of relapse, it is important to examine prevention, early intervention, and early recognition initiatives. The aim of this review is to identify and evaluate literature on preventative and early intervention programs in EDs.

METHODS

This paper is one of a series of Rapid Reviews, designed to inform the Australian National Eating Disorders Research and Translation Strategy 2021-2031, funded, and released by the Australian Government. To provide a current and rigorous review, peer-reviewed articles between 2009 and 2021 published in English were searched across three databases: ScienceDirect, PubMed and Ovid/Medline. Priority was given to high-level evidence including meta-analyses, systematic reviews, Randomised Control Trials, and large population studies. Findings from selected studies pertaining to prevention and early intervention in EDs were evaluated and are presented in this review.

RESULTS

In total, 130 studies were identified in the current review, 72% relating to prevention and 28% to early intervention. Most programs were theory-driven and targeted one or more ED risk factors such as thin-ideal internalisation and/or body dissatisfaction. There is reasonable evidence to support prevention programs reducing risk factors, particularly as part of school or university-based programs, with established feasibility and relatively high acceptance among students. There is increasing evidence around the use of technology (to increase dissemination potential) and for use of mindfulness approaches (targeting emotional resilience). Few longitudinal studies assessing incident cases following participation in a prevention program exist.

CONCLUSIONS

Although several prevention and early intervention programs have been shown to significantly reduce risk factors, promote symptom recognition, and encourage help-seeking behaviour, most of these studies have been conducted in older adolescent and university aged students, past the age of peak ED onset. One of the most targeted risk factors, body dissatisfaction, is found in girls as young as 6 years old, indicating a need for further research implementing prevention initiatives at younger ages. Follow-up research is limited; thus, the long-term efficacy and effectiveness of studied programs is unknown. Greater attention should be paid to the implementation of prevention and early intervention programs in identified high-risk cohorts or diverse groups, where a more targeted approach may be necessary.

“Why don’t I look like her?” How adolescent girls view social media and its connection to body image

Background

Adolescent girls appear more vulnerable to experiencing mental health difficulties from social media use than boys. The presence of sexualized images online is thought to contribute, through increasing body dissatisfaction among adolescent girls. Sexual objectification through images may reinforce to adolescent girls that their value is based on their appearance. This study explored how sexualized images typically found on social media might influence adolescent girls’ mental health, in positive and/or negative ways.

Methods

In-depth interviews were conducted with girls aged 14–17 years (n = 24) in Perth, Western Australia. Data were analyzed using thematic analysis.

Results

Participants identified body image as a major concern, reporting negative appearance comparisons when viewing images on social media. Appearance comparisons were perceived to exacerbate adolescent girls’ appearance-based concerns. Comparisons also influenced adolescent girls’ efforts to change their appearance and seek validation on social media. The importance of awareness and education from a younger age about social media and its influence on body image was emphasized, as was the need for strategies to promote positive body image and counteract negative body image.

Conclusion

The findings of this study have important implications for professionals working with adolescent girls and for the development of health promotion programs addressing social media use and body image concerns.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-022-01845-4.

The unique and moderated relationships across repetitive negative thinking and disordered eating behaviors in adolescent girls

OBJECTIVE

Repetitive negative thinking (RNT) is associated with eating disorder (ED) symptoms, but few studies have evaluated how RNT may relate to specific ED behaviors (e.g., fasting, binge eating). Furthermore, little research has examined RNT in adolescent girls, a critical population for ED development. Concern over mistakes perfectionism (i.e., preoccupation with and overvaluation of errors) and social appearance anxiety are transdiagnostic risk factors for EDs that may be amplified by RNT, contributing to the development of ED behaviors.

METHOD

The current study (N = 332 female high school students) explored RNT in an adolescent sample and tested whether RNT was uniquely associated with fasting/binge eating and moderated the relationships between social appearance anxiety/perfectionism and fasting/binge eating.

RESULTS

RNT was not associated with fasting and did not significantly moderate the relationship between social appearance anxiety/perfectionism and fasting. RNT was positively associated with binge eating but did not moderate the relationship between social appearance anxiety/perfectionism and binge eating.

CONCLUSIONS

RNT may contribute differentially to specific ED behaviors such as fasting and binge eating during ED development. If replicated in prospective data, these findings suggest targeting RNT in adolescence may decrease binge eating.

Social appearance anxiety moderates the relationship between thin-ideal internalization and eating disorder symptoms cross-sectionally and prospectively in adolescent girls

PURPOSE

The sociocultural theory of eating disorders (EDs) posits that thin-ideal internalization may interact with social risk factors to influence ED development. Social appearance anxiety (SAA) is a potential social risk factor for EDs that may influence the relationship between thin-ideal internalization and EDs.

METHODS

The current study (N = 525 adolescent females) examined whether SAA moderated the relationship between thin-ideal internalization and ED symptoms cross-sectionally and prospectively across one month.

RESULTS

The interaction between thin-ideal internalization and SAA on ED symptoms was significant in both models, such that when SAA was higher, there was a significantly stronger relationship between thin-ideal internalization and ED symptoms. We also found that SAA uniquely, prospectively predicted ED symptoms.

CONCLUSION

These results suggest that adolescents with high SAA and high thin-ideal internalization are more likely to exhibit higher ED symptoms. SAA both prospectively predicts ED symptoms and may amplify the relationship between thin-ideal internalization and EDs. This research highlights SAA as a social risk factor for ED development in adolescents. Interventions focused on SAA may optimize ED prevention in this population.

LEVEL OF EVIDENCE

Level IV, evidence obtained from multiple time series with or without the intervention.

Disordered eating, self-esteem, and depression symptoms in Iranian adolescents and young adults: A network analysis

OBJECTIVE

The network theory of psychopathology examines networks of interconnections across symptoms. Several network studies of disordered eating have identified central and bridge symptoms in Western samples, yet network models of disordered eating have not been tested in non-Western samples. The current study tested a network model of disordered eating in Iranian adolescents and college students, as well as models of co-occurring depression and self-esteem.

METHOD

Participants were Iranian college students (n= 637) and adolescents (n = 1,111) who completed the Eating Disorder Examination-Questionnaire (EDE-Q), Rosenberg Self-Esteem Scale (RSES) and Beck Depression Inventory, Second Edition (BDI-II). We computed six Glasso networks and identified central and bridge symptoms.

RESULTS

Central disordered eating nodes in most models were a desire to lose weight and discomfort when seeing one's own body. Central self-esteem and depression nodes were feeling useless and self-dislike, respectively. Feeling like a failure was the most common bridge symptom between disordered eating and depression symptoms. With exception of a few differences in some edges, networks did not significantly differ in structure.

DISCUSSION

Desire to lose weight was the most central node in the networks, which is consistent with sociocultural theories of disordered eating development, as well as prior network models from Western-culture samples. Feeling like a failure was the most central bridge symptom between depression and disordered eating, suggesting that very low self-esteem may be a shared correlate or risk factor for disordered eating and depression in Iranian adolescents and young adults.

Adolescent body image: influencing factors and the clinician's role

PURPOSE OF REVIEW

Body image is a crucial part of adolescent development for teens all over the world. Studies show that negative body image impacts many aspects of adolescent health and that anticipatory guidance about body image is important at the annual health maintenance exam visit. Weight bias is closely tied to body image and is associated with negative health effects as well; research shows weight bias is a problem throughout healthcare. The purpose of this review is to discuss influencing factors on adolescent body image and to explore interventions to promote positive body image.

RECENT FINDINGS

Research shows that adolescent body image is shaped by media influence, athletics and personal relationships. Studies have also begun to show that negative and positive body image are separate entities, and that overall health outcomes seem to be better in adolescents with positive body image. In thinking about intervention, there are ways to promote positive body image in the provider--patient interaction, within the school and community, in healthcare education, and at the societal level.

SUMMARY

Body image is an incredibly important aspect of adolescent health, and clinicians should be aware of ways to help promote positive body image in adolescents.

The Happy American Body 2.0: Predictors of affective body satisfaction in two U.S. national internet panel surveys

The first national study of body image was reported four decades ago in the article The Happy American Body (Berscheid et al., 1973). To provide a modern follow-up to this study, we used two Internet panel surveys of U.S. adults to examine feelings about appearance (Survey 1: Married N = 1095; Single N = 5481) and weight, appearance, body, and muscle size/tone (Survey 2: N = 1601). Mean ages across samples for men and women ranged from 42-53. On the positive side, many men and women were somewhat-to-very satisfied with their appearance (67 %; 57 %), overall body (61 %; 46 %), weight (54 %; 42 %), and muscle tone/size (56 %; 41 %). Mean gender differences were small (Cohen's ds = 0.18-0.32), as were sexual orientation differences within each gender (ds = |0.00-0.25|). Looking at negative body image, fewer men than women were somewhat-to-very unhappy with their appearance among married (19 %; 29 %) and single participants (29 %; 35 %), and fewer men were somewhat-to-extremely dissatisfied with their appearance (18 %; 24 %), body (27 %; 39 %), weight (36 %; 49 %), muscle tone/size (27 %; 41 %). Nearly one-fifth of men (18 %) and one-fourth of women (27 %) were very-to-extremely dissatisfied with at least one of these traits, highlighting the importance of body image interventions.

Prevention of eating disorders: 2019 in review

This article reviews 11 prevention-related publications in Eating Disorders: The Journal of Treatment & Prevention during 2019. Two models from the 2018 review continue to frame this analysis: (1) the Mental Health Intervention Spectrum from health promotion → types of prevention → case identification and referral → treatment; and (2) parsing phases of prevention into rationale, theory, and methodology → clarification of risk factors → implications for specific preventive interventions → design innovation and feasibility (pilot) research → efficacy and effectiveness research → program dissemination. These articles illustrate how the theoretical complexity and rigorous methodological demands of prevention science are manifest in the eating disorder field. A subset of articles also demonstrates the importance of working with researchers and community stakeholders to improve our understanding of how ethnicity, class, and gender intersect with planning for improvements in all phases of prevention. Other subsets show the need to expand the list of relevant risk factors, and how the traditional schema of masculinity creates both maladaptive biases in case identification and obstacles to an effective and compassionate understanding of EDs. Finally, implications of the absence of efficacy, effectiveness, and dissemination studies are discussed.